Derivation of candidates for the combat casualty critical care (C4) database

To describe the development of the Combat Casualty Critical Care Database, a comprehensive database of critically injured combat casualties to identify potentially modifiable risk factors for morbidity and mortality in this population.

The Department of Defense's Joint Theater Trauma Registry was queried for all combat casualties injured from February 1, 2002 through February 1, 2011. The search was limited to patients who required admission to the intensive care unit and survived to be evacuated to Landstuhl Regional Medical Center.

The query yielded 6,011 patients. The mean age was 25.7 ± 6.2 years. The majority of patients were male (98.3%), injured in Iraq (80%) and were members of the U. S. Army (72.6%). Most patients (58.0%) had an injury severity score in the lowest severity category (0-15). The mortality rate was 1.8%. The median day of death after injury (interquartile range) was 6 (3-14).

We identified a cohort of critically wounded combat casualties that encompasses the majority of such patients injured in the course of the wars in Iraq and Afghanistan. When this database is fully populated, rigorous epidemiologic analysis will seek to identify factors associated with morbidity and mortality to improve future care.